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CHAPTER 3: BIRTH AND THE NEWBORN CHILD
TABLE OF CONTENTS
LEARNING OBJECTIVES.......................................................................................................... 64
Section 1: Learning Objectives ............................................................................................... 64
Section 2: Learning Objectives ............................................................................................... 64
Section 3: Learning Objectives ............................................................................................... 64
KEY TERMS ................................................................................................................................ 64
Section 1: Key Terms.............................................................................................................. 64
Section 2: Key Terms.............................................................................................................. 65
Section 3: Key Terms.............................................................................................................. 65
CHAPTER OUTLINE .................................................................................................................................. 6466
I. Section 1: Birth and Its Cultural Context ...................................................................... 6566
II. Section 2: The Neonate .................................................................................................... 66
III. Section 3: Caring for the Neonate ................................................................................... 66
LECTURE NOTES ....................................................................................................................... 67
I. Section 1: Birth and Its Cultural Context ............................................................................... 67
A. The Birth Process ............................................................................................................... 67
1. Stages of Birth Process ..................................................................................................... 67
a. The First Stage: Labor ................................................................................................... 67
b. The Second and Third Stages: Delivery and Expelling the Placenta and Umbilical Cord
............................................................................................................................................ 67
2. Birth Complications .......................................................................................................... 68
a. Failure to Progress and Breech Presentation .................................................................. 68
b. Cesarean Delivery .......................................................................................................... 68
B. Historical and Cultural Variations ...................................................................................... 68
1. The Peculiar History of Birth in the West ........................................................................ 68
a. Early History: From Midwives to Doctors..................................................................... 68
b. The 20th Century: Slow Progress ................................................................................... 69
2. Cultural Variations in Birth Beliefs and Practices ............................................................ 69
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62
a. Beliefs and Rituals Surrounding Birth ........................................................................... 69
b. Who Helps? .................................................................................................................... 70
3. Cultural Variations in Methods for Easing the Birth ........................................................ 70
4 Cultural Variations in Neonatal and Maternal Mortality. .................................................. 71
II. Section 2: The Neonate ............................................................................................................ 71
A. The Neonate’s Health......................................................................................................... 71
1. Measuring Neonatal Health .............................................................................................. 72
2. Low Birth Weight ............................................................................................................. 72
a. Consequences of Low Birth Weight .............................................................................. 73
b. Treatment for Low Birth Weight Babies ....................................................................... 73
A. Physical Functioning of the Neonate ................................................................................. 74
1. Neonatal Sleeping Patterns ............................................................................................... 74
2. Neonatal Reflexes ............................................................................................................. 74
3. Neonatal Senses ................................................................................................................ 74
i. Touch .............................................................................................................................. 74
ii. Taste and Smell.............................................................................................................. 75
iii. Hearing ......................................................................................................................... 75
iv. Sight .............................................................................................................................. 75
III. Section 3: Caring for the Neonate ........................................................................................... 76
A. Nutrition: Is Breast Best? .................................................................................................. 76
1. Historical and Cultural Perspectives on Breast-Feeding .................................................. 76
2. Benefits of Breast-Feeding ............................................................................................... 76
B. Social and Emotional Aspects of Neonatal Care ............................................................... 77
1. Crying and Soothing ......................................................................................................... 77
a. Crying ............................................................................................................................. 77
b. Soothing and Responding to Cries ................................................................................. 78
2. Bonding: Myth and Truth ................................................................................................. 78
3. Postpartum Depression ..................................................................................................... 79
LECTURE LAUNCHERS, DISCUSSION IDEAS, AND ACTIVITIES.................................... 79
Section 1 Lecture Launcher: Midwife Training in the United States ..................................... 79
63
Section 1 Lecture Launcher: Childbirth Options .................................................................... 80
Section 1 Discussion: Student’s Ideas About Birth and the Neonate ..................................... 80
Section 1 Lecture Launcher: Are There Too Many Cesarean Section Deliveries? ................ 81
Section 2 Lecture Launcher: Low-Birth-Weight Babies ........................................................ 81
Section 3 Lecture Launcher: Breast-Feeding ........................................................................ 82
Section 3 Lecture Launcher: Supporting Breast-Feeding ..................................................... 88
Section 3 Lecture Launcher: Colic ....................................................................................... 89
CRITICAL THINKING ABOUT DEVELOPMENT .................................................................. 89
Evaluating Periodicals and Journals for Academic Use ......................................................... 89
SUPPLEMENTAL READINGS .................................................................................................. 91
MULTIMEDIA IDEAS ................................................................................................................ 91
TEXTBOOK FEATURES ............................................................................................................ 93
Video Guide ............................................................................................................................ 93
Birth and the Newborn Child (9:03; p. 83) ........................................................................... 93
Labor and Delivery (7:11; p. 86) .......................................................................................... 93
Neonatal Reflexes (1:15; p. 106) .......................................................................................... 93
Taste (2:02; p. 108) ............................................................................................................... 93
Cultural Focus ......................................................................................................................... 93
Breast-Feeding Practices Across Cultures (6:19; p. 113) ..................................................... 93
Research Focus (p. 116–117) .................................................................................................. 93
Breast-Feeding Benefits: Separating Correlation and Causation (3:45; p. 117) ................... 93
Research Focus Answers ...................................................................................................... 93
Soothing Methods (p. 121) ..................................................................................................... 93
Applying Your Knowledge as a Professional ......................................................................... 93
Career Focus: Birth Doula (p. 125)....................................................................................... 93
Critical Thinking Questions and Answers .............................................................................. 93
Section 1.................................................................................................................................. 93
Section 2.................................................................................................................................. 94
Section 3.................................................................................................................................. 94
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LEARNING OBJECTIVES
Section 1: Learning Objectives
3.1 Describe the three stages of the birth process and methods for easing its
discomfort.
3.2 Name two common types of birth complications and explain how they can be
overcome by cesarean delivery.
3.3 Summarize the history of birth in the West from the 15th century to today.
3.4 Describe cultural variations in birth beliefs and identify who may assist with the
birth.
3.5 Compare and contrast cultural practices and medical methods for easing the birth
process.
3.6 Describe the differences in maternal and neonatal mortality both within and
between developed countries and developing countries.
Section 2: Learning Objectives
3.7 Identify the features of the two major scales most often used to assess neonatal
health.
3.8 Identify the neonatal classifications for low birth weight and describe the
consequences and major treatments.
3.9 Describe neonates’ patterns of waking and sleeping, including how and why these
patterns differ across cultures.
3.10 Describe the neonatal reflexes, including those that have a functional purpose and
those that do not.
3.11 Describe the neonate’s sensory abilities with respect to touch, taste and smell,
hearing, and sight.
Section 3: Learning Objectives
3.12 Describe the cultural customs surrounding breast-feeding across cultures and
history.
3.13 Identify the advantages of breast-feeding and where those advantages are largest.
3.14 Describe neonates’ types of crying and how crying patterns and soothing methods
vary across cultures.
3.15 Describe the extent to which human mothers “bond” with their neonates and the
extent to which this claim has been exaggerated.
3.16 Describe the reasons for postpartum depression and its consequences for children.
KEY TERMS
Section 1: Key Terms
oxytocin p. 84
labor p. 84
delivery p. 85
episiotomy p. 85
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breech presentation p. 87
cesarean delivery (c-section) p. 87
obstetrics p. 89
forceps p. 90
natural childbirth p. 91
epidural p. 95
electronic fetal monitoring (EFM) p. 96
Section 2: Key Terms
fontanels p. 99
neonate p. 99
neonatal jaundice p. 99
anoxia p. 100
Apgar scale p. 100
Brazelton Neonatal Behavioral Assessment Scale (NBAS) p. 101
low birth weight p. 101
preterm p. 101
small for date p. 101
very low birth weight p. 102
extremely low birth weight p. 102
surfactant p. 103
kangaroo care p. 103
rapid eye movement (REM) sleep p. 105
reflex p. 106
rooting reflex p. 106
Moro reflex p. 107
sound localization p. 110
Section 3: Key Terms
mammary glands p. 112
let-down reflex p. 112
wet nursing p. 112
colostrum p. 114
swaddling p. 120
colic p. 121
imprinting p. 122
bonding p. 122
postpartum depression p. 123
CHAPTER OUTLINE
I. Section 1: Birth and Its Cultural Context
A. The Birth Process
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1. Stages of the Birth Process
a. The First Stage: Labor
b. The Second and Third Stages: Delivery and Expelling the Placenta and
Umbilical Cord
2. Birth Complications
a. Failure to Progress and Breech Presentation
b. Cesarean Delivery
B. Historical and Cultural Variations
1. The Peculiar History of Birth in the West
a. Early History: From Midwives to Doctors
b. The 20th Century Slow Progress
c. Birth Today in Developed Countries
2. Cultural Variations in Birth Beliefs and Practices
a. Beliefs and Rituals Surrounding Birth
b. Who Helps?
c. Easing the Birth
3. Cultural Variations in Methods for Easing the Birth
4. Cultural Variations in Neonatal and Maternal Mortality
II. Section 2: The Neonate
A. The Neonate’s Health
1. Measuring Neonatal Health
a. The Apgar Scale
b. The Brazelton Scale
2. Low Birth Weight
a. Consequences of Low Birth Weight
b. Treatment for Low-Birth-Weight Babies
B. Physical Functioning of the Neonate
1. Neonatal Sleeping Patterns
2. Neonatal Reflexes
3. Neonatal Senses
a. Touch
b. Taste and Smell
c. Hearing
d. Sight
III. Section 3: Caring for the Neonate
A. Nutrition: Is Breast Best?
1. Historical and Cultural Perspectives on Breast-Feeding
2. Benefits of Breast-Feeding
B. Social and Emotional Aspects of Neonatal Care
1. Crying and Soothing
a. Crying
b. Soothing and Responding to Cries
2. Bonding: Myth and Truth
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3. Postpartum Depression
LECTURE NOTES
I. Section 1: Birth and Its Cultural Context
A. The Birth Process
1. Stages of Birth Process
a. The First Stage: Labor
i. The first stage is the longest and hardest stage, lasting about 12
hours for first births and 6 hours for later births.
ii. During labor, the contractions of the muscles in the uterus
cause the mother’s cervix to dilate in preparation for the baby’s
exit.
iii. By the end of labor, the cervix has opened to about 10
centimeters.
iv. As time passes, contractions get stronger, more painful, and
closer together.
v. After the cervix opens, there may be a bloody discharge called
the bloody show.
vi. Having emotional support from health professionals and/or
family is crucial and helps ease discomfort.
b. The Second and Third Stages: Delivery and Expelling the Placenta and
Umbilical Cord
i. During delivery, the woman spends about 30–60 minutes
pushing the fetus through the cervix and out of the uterus.
ii. Contractions are less frequent than during labor and last about
60–90 seconds each.
iii. When the baby’s head appears, that is called crowning. If a
vaginal opening is too small and could or does tear, an
episiotomy may be performed to make the vaginal opening
larger and to speed the birth process.
iv. In the third and final stage of the birth process, contractions
continue as the placenta and umbilical cord are expelled from
the body, as well as a bloody vaginal fluid similar to a heavy
menstrual period. Breast-feeding during this stage facilitates the
contractions and helps push the placenta out.
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2. Birth Complications
a. Failure to Progress and Breech Presentation
i. Failure to progress occurs when the birth process is taking
longer than normal.
ii. Breech presentation of fetus means the fetus is turned around
so that the feet or buttocks are positioned to come first out of
the birth canal.
b. Cesarean Delivery
i. If birth complications take place, they can be overcome
through the use of a cesarean delivery or c-section, which
involves cutting open the mother’s abdomen and retrieving the
baby.
ii. Today, it is generally safe for mothers and infants when a c-
section is performed.
iii. WHO recommends that rates of c-sections should be below
15%. Critics suggest that some c-sections are not medically
necessary.
iv. Many women who give birth after a c-section go on to have
another c-section, but there is a possibility of a vaginal birth
called VBAC; it is generally safe for most women.
B. Historical and Cultural Variations
1. The Peculiar History of Birth in the West
a. Early History: From Midwives to Doctors
i. Throughout history, except during the 15th century witch hunting
madness, midwives facilitated birth.
ii. Midwives were again challenged in the 18th century by medical
doctors who thought they should deliver the babies.
iii. A new field of medicine developed called obstetrics. Doctors
introduced new methods for assisting delivery, like using tongs or
forceps to help extract the baby’s head. This sometimes damaged
the infant and is now rarely used.
iv. There have been attempts over the past several centuries to make
birth safer for baby and mother alike. In the early 19th century,
doctors spread deadly infections to mothers unwittingly by not
washing their hands. 1 in 20 women died of childbed fever.
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v. The use of midwives declined as the use of doctors and hospitals to
deliver babies grew increasingly popular. Now, about 10% of U.S.
babies are delivered by midwives, but in Norway, 96% are assisted
by midwives.
b. The 20th Century: Slow Progress
i. In the 20th century, the attempts were overzealous and overly
medical, as birth was taken over by doctors and hospitals with the
maternal experience disregarded.
ii. Episiotomies became common practice among doctors delivering
babies.
iii. Doctors commonly prescribed medication to ease the pain of
childbirth in developed countries. However, some of these methods
were dangerous for mother and baby. Inducing twilight sleep was
common practice, but stopped around the 1960s.
iv. In the past 50 years, most of the West has moved toward a more
reasonable middle ground, seeking to minimize medical
intervention, but make it available when necessary. This produced
resurgence in the use of midwives.
v. Natural childbirth was advocated by critics of the medical
approach to childbirth; however each has been established as
producing equally healthy outcomes.
vi. Natural childbirth methods for at home births are much riskier for
the mother and baby than in a hospital setting and are not
recommended for high-risk pregnancies.
vii. Births in developed countries are now seen as a collaborative
experience between the mother, baby, medical professionals, and
family members.
2. Cultural Variations in Birth Beliefs and Practices
a. Beliefs and Rituals Surrounding Birth
i. Cultural practices regarding birth vary from celebrating the mother
and child to segregating them during and after the birthing process
because the mother is unclean or to keep from endangering the
infant.
ii. The motivation for such beliefs appears to be the desire for control.
iii. The placenta is often disposed of with care in traditional cultures
because of beliefs that it is potentially dangerous or even semi-
human.
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iv. In developing countries, disposal techniques include burial,
burning, or throwing it away.
v. In developed countries, placentas (which are nutrient rich) may be
donated to research or sold to cosmetic companies. Although rare,
some people even eat the placenta.
b. Who Helps?
In traditional cultures, the older women in the family and older women
who have specialized training, known as midwives, consistently assist in
the birth. Men most often do not assist or are completely excluded.
i. A woman may become a midwife if she received a “calling,” had a
mother who was a midwife, or just wanted to volunteer.
ii. It requires years of apprenticeship and is generally a highly
respected position, except in cultures that view birth as unclean.
iii. Now, births in developed countries usually take place in a medical
setting and health professionals provide the care. This is becoming
more common in developing countries as well.
3. Cultural Variations in Methods for Easing the Birth
i. In traditional cultures, midwives provide methods for easing the
birth beginning early in the pregnancy with prenatal visits,
massages, herbal teas, and advice on diet and exercise.
ii. In developing countries, a midwife is the primary person to ease
the birth, along with family support, usually female relatives who
provide advice, encouragement, instructions, and imagery to ease
the pain and speed up the labor.
iii. Sometimes a shaman or religious leader provides spiritual
assistance.
iv. Invoking magic does not directly provide medical relief, but the
placebo effect can be powerful.
v. In developed countries, emotional and social support are also
common.
vi. Health professionals suggest a variety of methods to ease
discomfort, such as walking, slow breathing, and rocking.
vii. In developed countries, an anesthetic drug called an epidural,
which is injected into a woman’s spinal fluid, is used to help
manage the pain during labor. Its use is very common in the United
States, but somewhat limited on other developed countries. It
varies.
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viii. Medical technology has made birth safer for mothers and babies.
Doctors now use a vacuum cup to pull out the baby, which is safer
than using forceps. They also often rely on electronic fetal
monitoring (EFM) to monitor the fetus’s heart rate and potential
for distress.
ix. Most cultures also encourage the mother to be upright or somewhat
upright during the process to make use of gravity.
x. The birth is not complete until the placenta has been expelled.
Many strategies are used to facilitate this process, which may
include massage and traditional and herbal medications. Finally,
the umbilical cord is cut and the process is complete.
4. Cultural Variations in Neonatal and Maternal Mortality
i. In recent decades, birth has become routinely safe and humane in
developed countries.
ii. Birth remains highly dangerous in less-developed countries and in
developed countries, like the United States, among those who are
poor and where little medical intervention is available.
iii. Maternal mortality has improved over the last 30 years due to
better nutrition and access to health care in developing countries.
iv. In the United States, neonatal mortality is similar among Whites,
Latinos, and Asian Americans, but it is twice as high for African
Americans. However, maternal mortality has been rising and is
highest among African Americans.
II. Section 2: The Neonate
A. The Neonate’s Health
i. At birth, the baby may be covered by fine, fuzzy hair called lanugo
and/or a white substance called vernix.
ii. Neonatal skulls are not one solid, hard bone, but several pieces
joined together. The two soft spots on the top and toward the back
of the head are called fontanels. Caregivers must be careful of
these soft spots until they have disappeared at about 18 months of
age.
iii. The average newborn is 20 inches long and weighs about 7.5
pounds at birth, although most neonates lose about 10% of their
body weight in the first few days after birth.
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iv. Neonates are at risk of developing neonatal jaundice due to an
immature liver. It causes them to have a yellowish tint to their skin
and eyes during the first week, but it is easily treated.
1. Measuring Neonatal Health
i. Neonatal health is often measured immediately after birth and
again in the first few minutes of life or up to one day to two
months later. One important indicator of health is the newborn’s
ability to breathe on his or her own. The inability to breathe can
quickly result in damaging oxygen deprivation called anoxia.
ii. Two common Western methods to test neonatal health are the
Apgar Scale and the Brazelton Neonatal Behavioral Assessment
Scale (NBAS).
iii. The Apgar Scale
a. The Apgar is comprised of 5 tests to check the newborn’s
Appearance, Pulse, Grimace, Activity, and Respiration on a
scale from 0–2 for a total possible score of 10. A score of 7
or above is excellent, while a score of 4–6 is a cause for
concern, and 3 or less is life threatening. The test is given at
1 and 5 minutes after birth.
iv. The Brazelton Neonatal Behavioral Assessment Scale
a. NBAS is used to rate neonates on 27 items such as reflexes,
physical states, responses to social stimuli, and CNS
instability. Newborns are rated as worrisome, normal, or
superior. Ideally, this test should be administered one day
and one week after birth, but can be up to two months.
v. The NBAS is a good predictor of future development and can
promote a good relationship between parents and their infants.
vi. According to research on the NBAS, quick, loving, attentive
parenting better promotes healthy development, especially for
babies who were rated as worrisome a day after birth.
2. Low Birth Weight
i. Low birth weight (LBW) neonates weigh less than 5.5
pounds.
ii. LBW is common for preterm neonates who were born 3 or
more weeks early; others may be small-for-date because they
weigh less than 90% of other neonates of the same gestational
age.
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iii. LBW varies by world region, ethnicity, SES, and levels of
maternal stress.
iv. Causes of LBW in developing countries include malnourished
mothers, poor health, and lack of prenatal care; whereas
cigarette smoking is the leading cause of LBW in developed
countries.
v. Other causes include multiple births, substance use and
younger than 17 or older than 40 maternal ages.
a. Consequences of Low Birth Weight
i. LBW babies are at high risk of death; it is the second most
common cause of infant death in developed countries.
ii. Very low birth weight (less than 3.3 pounds) and extremely
low birth weight (less than 2.2 pounds) are at great risk of
death, even in the United States it is 25% for VLBW neonates.
iii. Preterm neonates are not fully developed and may have a host
of related problems, such as immature immune systems and
lungs. They do not have the ability to regulate their body heat.
iv. Preterm neonates have not yet developed surfactant, a coating
in the lungs that keeps them from collapsing and helps them
breathe. With advanced medical care, surfactant can be
administered and increases their chances for survival.
b. Treatment for Low Birth Weight Babies
i. Daily, close physical contact in which the infant and caregiver
are skin-to-skin is called kangaroo care. The outcomes
improve substantially for those who use this technique.
ii. Infant massage can help ameliorate LBW problems also,
especially when the neonate is placed in an isolette for
protection. Infant massage can relieve isolation, improve
weight gain, and increase activity and alertness.
iii. However, these treatments cannot alleviate all problems
associated with LBW. Low birth weight is related to a variety
of physical, cognitive, and behavioral problems not just in
infancy, but also throughout life, if the newborn survives. In
fact, the lower the birth weight, the worse the problems are
expected to be.
iv. Enriched environments can help overcome some of the
negative consequences of LBW babies.
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A. Physical Functioning of the Neonate
1. Neonatal Sleeping Patterns
i. Neonates sleep an average of 16 to 17 hours a day (in segments
of a few hours each). This sleep pattern is not very compatible
with adults and often results in sleep deprivation.
ii. By four months old the typical infant sleeps for 14 of every 24
hours, including about 6 hours at night.
iii. Infants’ REM sleep is different from adults. REM stands for
rapid eye movement.
a. Neonates spend about 50% of sleep in REM compared with
20% for adults.
b. Neonates enter REM immediately upon sleeping, while adults
take about an hour; it is a dreaming phase for adults, but likely
a brain development stimulation phase for neonates.
iv. Developed countries have produced most of the sleep-wake
research with neonates. But infant caregiving practices vary by
culture and that influences the sleep-wake pattern. In
traditional cultures where babies are closely held by mothers,
the infants nap and doze more and have fewer long periods of
sleep.
2. Neonatal Reflexes
i. There are 27 reflexes (automatic responses to stimuli) present
at birth or shortly after, including some related to early survival
(such as sucking and rooting and the Moro reflex).
ii. Some reflexes are precursors of voluntary movements that will
develop later, such as the stepping and swimming reflexes, and
others that have no apparent function (such as the Babkin and
Babinski reflexes).
iii. Reflexes fade after a few months, but they are important
indicators of normal, healthy neurological development and
functioning early on.
3. Neonatal Senses
i. Touch
a. Touch is the earliest sense to develop in utero (at 2 months
gestation).
b. Research on touch demonstrates that newborns do feel pain
similar to adults, contrary to previously held beliefs. Pain
relief is now provided for medical procedures.
75
ii. Taste and Smell
a. The sense of taste is well developed in the womb.
b. Neonates show a preference for tastes that they experienced
in utero.
c. Infants prefer sweet over bitter or sour tastes. In fact, breast
milk is slightly sweet. Sweet tastes have a calming effect
on pain.
d. Neonates also quickly begin to discriminate smells after
birth, showing a preference for the smell of their mother’s
breast and other sweet smells.
iii. Hearing
a. Hearing is also quite mature at birth, and they can
recognize their mothers’ voices and other familiar sounds
heard in the womb.
b. They are sensitive to human speech and show a preference
for their mother’s voice and their native language.
c. They can even recognize subtle differences in speech
sounds, including differences in two and three syllable
words.
d. Neonates like the sound of music and prefer the music and
songs they heard while in the womb.
e. Hearing is good at birth, but does improve over time, as
does sound localization.
iv. Sight
a. Sight is the least developed of the senses at birth, due to the
physiological immaturity of the visual system at birth, but
reaches maturity by the end of the first year.
b. At birth, vision is best about 8–14 inches from the targeted
object.
c. By about 3–4 months of age, infants develop binocular
vision; that is, combining information from both eyes for
perceiving depth and motion, as well as the ability to detect
colors like an adult.
d. Most preferred visual stimuli for a newborn? Human faces.
76
III. Section 3: Caring for the Neonate
A. Nutrition: Is Breast Best?
1. Historical and Cultural Perspectives on Breast-Feeding
a. A mother’s breasts change during pregnancy to ready for
milk production. For example, the mammary glands
expand as milk producing cells multiply and mature.
b. A lactating mother’s let down reflex is activated when the
infant suckles at her breast for about 30 seconds. It can also
be activated when she hears an infant cry, sees her infant’s
hunger signs, or imagines breast-feeding.
c. Historically, infants were solely breast-fed for about 2–3
years and occasionally for another 2–3 years.
d. In traditional cultures in developing countries (even in
modern times), infants are fed very frequently because
mother’s practice kangaroo care.
e. This practice is time consuming and demanding on
mothers. Sometimes they use non-human animal milk as a
substitute or hire another lactating mother, a wet nurse, to
feed the infant.
f. In developed countries, synthesized milk products were
used beginning in the late 1800s and continue to be used
today due to their convenience.
g. In the United States, breast-feeding rates dropped as low as
20% in the 1940s, but with the surge of research supporting
the efficacy of breast-feeding, rates are up over 70% today
for any duration.
h. In the United States, rates of any breast-feeding are highest
among Latinos and Whites, but fewer than half of infants
are still breast-fed at 6 months of age.
2. Benefits of Breast-Feeding
a. Breast-feeding is beneficial to infants in many ways,
including offering protection from disease in infancy, better
health in childhood and adulthood, healthy cognitive
development, and reduced obesity if breast-fed for at least 6
months.
b. Breast-feeding also has benefits for the mother, such as
promoting uterine contractions, weight loss, and bone
strength. In addition, it can reduce their risk of ovarian and
77
breast cancers and it suppresses ovulation while breast milk
is the sole source of food.
c. The thick yellowish liquid the mother produces in the first
few days is called colostrum or first milk. It is like liquid
gold for the newborn because it is rich in protein and
immune boosting antibodies.
d. Breast-feeding is especially important in developing
countries due to the risk of disease and infection from
mixing infant formula with contaminated water, which
could result in infant death.
e. The benefits of breast-feeding are smaller in developed
countries.
f. Some mothers experience difficulties with breast-feeding,
such as improper latching or a lack of milk supply that can
impede breast-feeding. Other obstacles may include a
mother’s work schedule and an unsupportive work or social
environment. Desire to include the father in the feedings
also impedes breast-feeding, but the mother can pump and
store her milk as an alternative.
g. A small percentage of mothers who have infectious
diseases, such as HIV/AIDS, TB, or West Nile virus are
advised not to breast-feed because they could transmit the
disease to the infant.
h. Rates of breast-feeding declined because of the availability
of formula, but it is still not as good as breast milk.
i. Despite a WHO/UNICEF initiative to promote breast-
feeding, unfortunately, worldwide only about half of all
infants are breast-fed even for a short time.
B. Social and Emotional Aspects of Neonatal Care
1. Crying and Soothing
a. Crying
i. Three distinct kinds of crying signals have been identified:
fussing, anger cry, and pain cry.
a. Fussing is a mildly distressed cry meant to alert the
caregiver.
b. The anger cry is loud and usually comes after no one
responds to fussing.
78
c. The pain cry is not preceded by fussing; it has a sudden
onset after taking in a big breath and holding it, the infant
then cries loudly.
ii. There are other types of less distinctive types of crying, but they
are generally referred to as a basic cry or frustration cry.
iii. Universally, crying frequency rises steadily beginning at 3 weeks
of age and reaches a peak by the end of the second month, then
declines.
b. Soothing and Responding to Cries
i. The duration and intensity of crying is lower in cultures where
young infants are held or carried throughout much of the day and
night.
ii. Parents should be familiar with the normal features of crying. The
Period of PURPLE crying in the early months educates parents
about crying and lets them know that crying does have a beginning
and end.
iii. In studies, the frequency and duration of crying was reduced in
babies that were held more and responded to quickly.
iv. In traditional cultures, babies who cry are usually offered the
breast for feeding or suckling comfort or they are swaddled in a
tightly wrapped cloth that binds their arms and legs.
v. For most babies, gentle, repetitive motions like rocking and patting
are soothing.
vi. Studies on responding to crying have been inconclusive, but we do
know that it is not related to infant development long term.
vii. When a baby cries for more than 3 hours a day for 3 days in a row
for over 3 weeks, the baby is said to have colic. This is most
common in Western cultures.
2. Bonding: Myth and Truth
i. Humans do not imprint, an instant enduring bond that develops
with the first moving object seen, like goslings.
ii. Some physicians have claimed on the basis of animal studies that
the first few minutes and hours after birth are critical to mother-
infant “bonding.” This has now been shown to be false, but the
claims had the beneficial effect of changing hospital policies to
allow more contact between mothers, fathers, and neonates.
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3. Postpartum Depression
i. Many mothers experience mood fluctuations in the days following
birth as their hormones return to normal levels termed “baby
blues.”
ii. Some 10% of mothers and 4% of fathers experience an extended
period of deep postnatal depression, known as postpartum
depression (PPD).
a. PPD is worse than baby blues, with intense feelings of
sadness and anxiety that may interfere with the caregiver’s
ability to care for the infant and herself.
b. PPD can go on for 6 months or longer in 25–50% of
women.
c. Women are more likely to develop PPD if they have a
genetic vulnerability, a history of major depression, and a
lack of social support.
d. Infants and children who have or had a parent(s) with PPD
are at risk for poor developmental outcomes. When cared
for by a mother or father with PPD, infants are more likely
to have behavioral and emotional problems and to have
problems later on.
LECTURE LAUNCHERS, DISCUSSION IDEAS, AND ACTIVITIES
Section 1 Lecture Launcher: Midwife Training in the United States
There are three professional associations related to the midwife profession. They are the
American College of Nurse-Midwives (ACNM), the Midwives Alliance of North America
(MANA), and the National Association of Certified Professional Midwives (NACPM). The
ACNM’s certifying organization is the American Midwifery Certification Board (AMCB), while
the MANA and NACPM are certified by the North American Registry of Midwives (NARM).
These most highly recognized and rigorous programs are accredited by the American College of
Midwifery Education (ACME). The AMCB requires a graduate degree in midwifery education
and recertification every five years. As of 2011, there were 39 accredited programs in the United
States. Qualified applicants have a variety of backgrounds, but the majority of them are already
registered nurses. For those, the midwife program is usually 2 years of graduate education,
including clinical training. These graduates can be licensed in all states, D.C., and U.S. territories
as a certified nurse-midwife once they pass the American Midwifery Certification Board
(AMCB) exam. Certified Nurse Midwives have prescription privileges, can practice in all
medical and private settings, and are eligible to accept insurance.
Source:
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American College of Nurse Midwives website. Retrieved from www.midwife.org.
Section 1 Lecture Launcher: Childbirth Options
Methods of childbirth have changed dramatically in the last 50 years. Most current methods are
based on the pioneering work of Grantly Dick-Read in England and Ferdinand Lamaze in
France. In 1944, Dick-Read proposed that fear is the major cause of most of the pain of
childbirth. He proposed the concept of natural childbirth and developed a method of teaching
women about reproduction, pregnancy, delivery, and exercises in breathing, relaxation, and
fitness. Lamaze, in the 1950s, developed a method called prepared childbirth where expectant
mothers are taught to breathe and concentrate on sensations other than contractions. This is
facilitated by a “coach,” usually the father, who attends classes with them and helps time their
breathing. Fathers then became a part of the childbirth process, and by the 1970s hospitals were
beginning to allow them to go into the delivery room to assist. Now, most fathers elect to
participate in the birth of their children.
Although 99% of all babies born in the United States are born in hospitals, some women elect to
have their babies at home with the services of either a physician who specializes in home births
or a midwife, a specially trained nurse. This option should be used only by women whose
pregnancies are low-risk. Hospitals responded to the home-birth movement by offering birthing
centers with rooming-in facilities so mothers and babies are together all day, and allowing
sibling visitations.
Source:
Sullivan, D.A. & Weitz, R. (1988). Labor pains: Modern midwives and home birth. New
Haven, CT: Yale University.
Section 1 Discussion: Student’s Ideas About Birth and the Neonate
Divide the class into several groups. Each group should discuss one or more of the following:
1. List the pros and cons of home birth versus hospital birth.
2. What key factors should a woman consider in deciding whether to return to work or not after
having a baby?
3. What are the pros and cons of having fathers and siblings more involved in childbirth?
4. What are reasons that people have children? How valuable are children? Why do many
cultures prefer male children?
Have a representative from each group present the group’s findings to the class.
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Section 1 Lecture Launcher: Are There Too Many Cesarean Section Deliveries?
More cesarean section deliveries (c-sections) are performed in developed countries than in
developing nations (Gibbons, et al., 2012). Brazil has the highest number of deliveries via c-
section than any other country at 46%. Reasons for cesarean delivery include: labor is
progressing poorly, the mother has had a previous c-section (although many women can
successfully deliver vaginally after a previous c-section), the baby is in the breech or transverse
position, the mother has an active case of genital herpes, and to avert potential malpractice suits.
Some critics argue that the use of a fetal monitor has increased the incidence of c-sections
(Stafford, 1990). It is possible that many c-sections are actually medically unnecessary
(Gibbons, et al., 2012) Babies born by c-section miss out on the stress hormones released during
birth (catecholamines) (Stafford, 1990). These hormones are believed to help in the post-birth
breathing process. The effects on mothers are a result of the major abdominal surgery involved,
which is associated with a longer hospital stay, longer recovery, higher rates of postpartum
depression, and a greater risk of infection. As a result of criticisms, the rate has dropped since
the 1980s.
Sources:
Gibbons, L., Belizan, J. M., Lauer, J. A., Betran, A. P., Merialdi, M., & Althabe, F. (2012).
Inequities in the use of cesarean section deliveries in the world. American Journal of
Obstetrics and Gynecology, 206(4), 331.e1-331.e19.
Stafford, R.S. (1990). Alternative strategies for controlling rising cesarean section rates.
Journal of the American Medical Association, 263, 683–687.
Section 2 Lecture Launcher: Low-Birth-Weight Babies
The number one risk factor associated with death in infants in the first months of life is low birth
weight. Low birth weight (LBW) is defined weighing less than 5.5 pounds for a full-term infant.
Low-birth-weight babies also spend more time in intensive-care nurseries at an annual cost of
over $2 billion (Cristafi & Driscoll, 1991).
Research in the United States indicates several conditions contribute to the possibility of LBW
(Cristafi & Driscoll, 1991):
maternal hypertension
rubella during the first 16 weeks of pregnancy
urogenital infections
diabetes
more than four previous pregnancies
teenage mother or mother over age 35
mother underweight or malnourished
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cigarette or marijuana smoking
having two or more abortions
anemia
exposure to teratogens
maternal stress
According to research by UNICEF, an estimated 15% of neonates born in developing countries
are LBW, with South East Asia at 27%. The biggest contributors of LBW in these countries are
poor maternal nutrition and poor maternal health prior to conception due to illness and diseases.
However, these statistics may underreport the problem as many neonates in these regions are not
weighed at birth because they are not born in a medical facility.
Sources:
Cristafi, M.A., & Driscoll, J.M. (April, 1991). Developmental outcome in very-low-birth-weight
infants at three years of age. Paper presented at the biennial meeting for the Society for
Research in Child Development, Seattle.
Singer, L.T., Yamashita, T.S., & Baley, J. (March/April, 1995). Maternal distress and medical
complications predict developmental outcome in very-low-birth-weight (VLBW) infants
to 2 years. Paper presented at the biennial meeting for the Society for Research in Child
Development, Indianapolis.
UNICEF global databases 2010, from Multiple Indicator Cluster Surveys (MICS), Demographic
Health Surveys (DHS) and other national surveys. Retrieved from
http://www.childinfo.org/low_birthweight_status_trends.html
UNICEF/WHO, Low Birthweight: Country, regional and global estimates, UNICEF, New York,
2004.
Section 3 Lecture Launcher: Breast-Feeding
List the advantages and disadvantages of breast-feeding versus bottle-feeding for mothers and for
infants. You may want to share a fascinating article with your students after this activity.
Catharina Svanborg, a Swedish physician and immunologist, has discovered that a component of
ordinary breast milk kills cancer cells in infants. Besides its newfound cancer-destroying
properties, breast milk protects the infant against:
Diarrhea
Lower respiratory infection
Otitis media (ear infection)
Bacteremia
Bacterial meningitis
Botulism
Urinary tract infection
Necrotizing enterocolitis
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Sudden infant death syndrome
Insulin-dependent diabetes mellitus
Crohn’s disease
Ulcerative colitis
Allergies
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According to an article in Discover, the American Academy of Pediatrics recommends the
following.
Human milk is the preferred feeding for all infants, including premature and sick newborns.
Breast-feeding should begin as soon as possible after birth, usually within the first hour.
Newborns should be nursed whenever they show signs of hunger—increased alertness or
activity, mouthing, or rooting.
No supplements (water, glucose water, formula, etc.) should be given to breast-feeding
newborns unless for medical reasons. Pacifiers should be avoided.
Breast-feeding provides ideal nutrition. It is all an infant needs for optimal growth and
development for the first 6 months.
Source:
Radetsky, P. & Wester, T. (June, 1999). Got cancer killers? Discover. 68–75. Retrieved from
http://discovermagazine.com/1999/jun/featcancer
Section 3 Lecture Launcher: Supporting Breast-Feeding
Based on extensive research, we all know that breast milk is very healthy for infants, with few
exceptions. Arnett (2012) notes benefits of breast-feeding in the text. How does the Unites States
stack up when it comes to breast-feeding?
In developed countries, particularly the United States, there can be many obstacles to breast-
feeding. Mothers without a good support network and a lack of education about the importance
of breast-feeding may grow quickly discouraged and switch to formula. According to the Breast-
Feeding Report Card produced by the CDC (2011), 75% of mothers in the United States attempt
to breast-feed, but that number dwindles quickly. Within two days of birth, 25% of breast-fed
infants begin receiving formula to supplement breast milk or replace it entirely. By three months
of age, only 35% of U.S. infants are exclusively breastfed.
The CDC evaluates several process indicators to determine how well breast-feeding is supported
in the United States. These indicators include support from the birth facility, the amount of
professional lactation support from Certified Lactation Consultants, support from other mothers
who are trained La Leche League Leader volunteers, the type of and amount of infrastructure
provided by the state, and support in child care settings.
Less than 5% of live births in the United States occur at a birth facility that has been rated as
baby friendly. There are only 2.67 certified lactation consultants and fewer than one La Leche
League Leader available for every 1,000 live births in the United States. There are only 125 state
health department employees who have a full-time position dedicated to promoting and
supporting breast-feeding initiatives. Finally, only six states have optimal regulations in place to
provide breast-feeding support via child care facilities.
More detailed information is available at http://www.cdc.gov/breast-feeding/data/reportcard.htm
which is the Breast-Feeding Report Card for 2014.
In addition, you may want to customize your lecture by providing additional information on how
your state is doing compared to the national averages.
89
Sources:
2009 CDC Maternity Practices in Infant Nutrition and Care (mPINC) Survey.
Centers for Disease Control and Prevention (2011). Breast-Feeding Report Card–United States,
2014. Retrieved from http://www.cdc.gov/breast-feeding/pdf/2014breast-
feedingreportcard.pdf
Section 3 Lecture Launcher: Colic
The Mayo Clinic provides an excellent overview of colic, including a definition, symptoms,
causes, risk factors, complications, testing and diagnosis, treatment, and suggestions for coping
and support. I find that students frequently ask about this and would like more information.
About 25% of infants may be affected with colic, according to the Mayo Clinic (2011). The
onset of colic is usually evident when the infant is just a few weeks old and may last about 3
months. Although we do not know what causes colic in infants, we do know that pre- and post-
natal maternal smoking is a risk factor. It is important to have infants medically evaluated for
colic to make sure that is what they have. There are several medical conditions, such as pyloric
stenosis or an intestinal obstruction that could cause sustained periods of inconsolable crying.
Note that colic is temporary and that having support and child care respite is helpful for
maintaining a positive attitude and good mental health.
Source:
Mayo Clinic staff (2015). Colic. Retrieved from http://www.mayoclinic.org/diseases-
conditions/colic/basics/definition/con-20019091
CRITICAL THINKING ABOUT DEVELOPMENT
Evaluating Periodicals and Journals for Academic Use
Understanding the Concept
Very few students come to college understanding the standards that will be expected of them for
selecting and using resources. When writing an essay or a paper and when supporting your
opinions in college, not all resources are acceptable.
This exercise introduces you to differences between sources written for the general public, and
scholarly journals with peer-reviewed articles for academic use. Rather than reading about the
differences, see the differences with the exercise below.
Critical Thinking Challenge, Periodical Evaluation
1. Begin by examining two periodicals. Go to your school or public librarian and access free
copies of Parenting Magazine and find an article on newborns. Go to http://jama.ama-
assn.org/ and enter “newborn or neonate” in the search box. Choose an article and click on
full text.
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2. Compare each source in the following table and circle their scores.
Parenting JAMA
1. List author’s discipline
and degrees.
2. Author’s work has been
reviewed by knowledgeable
peers in their field.
( )Yes +5 ( )No ( )Yes +5 ( )No
3. Sources the author used
are cited.
( )Yes +5 ( )No ( )Yes +5 ( )No
4. References are given
after the article.
( )Yes +5 ( )No ( )Yes +5 ( )No
5. Includes number and
characteristics of subjects
in studies.
( )Yes +5 ( )No
( ) NA, no study included.
( )Yes +5 ( )No
( ) NA, no study included.
6. Describes research
method in detail.
( )Yes +5 ( )No
( ) NA, no research
included.
( )Yes +5 ( )No
( ) NA, no research included.
7. Has advertisements for
products related to articles.
( )Yes -5 ( )No ( )Yes -5 ( )No
8. Has conflict of interest
disclaimers.
( )Yes +5 ( )No ( )Yes +5 ( )No
9. Different opinions or
weaknesses in the
information are discussed.
( )Yes +5 ( )No ( )Yes +5 ( )No
10. Fact, theory, and
opinion are easy to tell
apart.
( )Yes +5 ( )No ( )Yes +5 ( )No
Total Points
3. Summarize in writing the differences you see between the publications and their
weaknesses or strengths as appropriate academic sources for information.
Instructor’s Guide
This exercise works well as an individual assignment followed by class or small group
discussion if time allows. You may wish to select your own set of periodicals. The Journal of the
American Medical Association provides full text articles at no cost. If your students have access
to free databases the selection of journals you might wish to use will be larger.
The exercise transfers most easily to online discussion by preselecting periodicals available to
your students online for free. For a forum, have students use the table as a guide, and then submit
their written summary and comments in the discussion board.
91
SUPPLEMENTAL READINGS
Bean, C. (1990). Methods of childbirth (Rev. Ed.). New York: Quill.
Brazelton, T.B., Nugent, J.K., & Lester, B.M. (1987). Neonatal Behavioral Assessment Scale.
In J.D. Osofsky (Ed.), Handbook of infant development (2nd. Ed.). New York: Wiley.
Eisenberg, A., Murkoff, H.E. & Hathaway, S.E. (1989). What to expect in the first year. New
York: Workman.
Frey, D. (July 9, 1995). Does anyone here think this baby can live? The New York Times
Magazine. pp. 22–47.
This article presents a true story of a 24-week-old fetus who is born prematurely and
discusses the decisions involved in whether to use medical technology to keep the baby
alive.
Karr-Morse, R., Wiley, M., and Brazelton, T. (1999). Ghosts from the nursery: Tracing the
roots of violence.
This book details recent research about the importance of a healthy prenatal environment.
Leboyer, F. (1975). Birth without violence. New York: Knopf.
Murkoff, H, Hathaway, S., & Eisenberg, A. (2002). What to expect when you’re expecting.
This book covers important topics such as exercise, childbirth options, multiple births,
choosing a caregiver, and common (and uncommon) problems. It’s a comprehensive,
straightforward guide to labor, delivery, postpartum care, breast-feeding, and more.
There is a section for fathers-to-be also.
Smith, R. (March, 1999). The timing of birth. Scientific American. Scientists have recently
discovered a hormone in the human placenta that tells the pregnant woman’s body to
begin labor.
Warrick, P. (March 1, 1992). The fantastic voyage of Tanner Roberts. The Los Angeles Times.
pp. E1, E12–13.
This fascinating article relates a typical birth.
MULTIMEDIA IDEAS
After the Baby Comes Home (Films for the Humanities and Sciences, 19 minutes)
This film shows how new parents can prepare for the stress of the new baby, including
postpartum depression, marital stress, exhaustion, and the reactions of siblings.
The Amazing Newborn (Polymorph Films, 1975, 26 minutes)
This film emphasizes the sensory capabilities of the newborn.
Babywatching (Films for the Humanities and Sciences, 50 minutes)
Based on the best-selling book by Desmond Morris, this program depicts the world
through the eyes of a baby.
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Birth and the Newborn (Concept Media, 27 minutes)
A video describing various childbirth practices.
Birth at Home (Filmmakers Library, 14 minutes)
A fascinating film about a home birth in Australia assisted by a midwife.
The Dad Film (Fanlite Productions, 1991, 28 minutes)
This video assuages the anxieties of “expectant dads” and encourages the involvement of
fathers in the birth experience.
Easier to Bear (ABC News/Prentice Hall, 1994, 12 minutes)
A 20/20 segment that deals with underwater birth as an alternative method to ease the
pain of childbirth. Both pros and cons are discussed. Several underwater births are
shown.
First Adaptations (Insight Media, 1992, 30 minutes)
Describes capabilities infants have to survive and learn by their senses.
Five Women, Five Births (Davidson Films, 29 minutes)
This film shows two home births and three hospital births.
It’s Our Baby: Parents Talk About Certified Nurse-Midwife Birth Care (The Cinema Guild,
1992, 25 minutes)
Dispels common misconceptions and shows what midwives do.
A Joyous Labor (Filmmakers Library, 1987, 30 minutes)
Explores birth options: hospital, home births, birthing centers and the methods used in
each setting.
Labor and Delivery (Injoy Productions, 35 minutes)
This video details the labor and delivery process and includes interviews with mothers
and fathers during the last weeks of pregnancy and after delivery.
The Miracle of Birth (AIMS Media, 1989, 30 minutes)
This video presents information on childbirth.
The Newborn (Films for the Humanities and Sciences, 23 minutes)
This program shows the reactions of newborns 10 days after birth and important
functions of infancy such as sitting, standing, walking, and social contact.
Prenatal Development and the Birth Process (World of Childhood Series #3, University of
Nebraska, Great Plains National Instructional Television Library, 1992, 28 minutes)
This video provides an overview of prenatal development, including a live ultrasound
sonogram. It takes the viewer through the birth process from different cultural
perspectives. It also provides a history of different methods of childbirth.
The Process of Birth (Films for the Humanities and Sciences, 23 minutes)
93
This program shows how different cultures and different individuals determine the best
birth position, whether births should take place in a hospital, who should be in attendance
at the birth, and whether mother should breast-feed the newborn.
TEXTBOOK FEATURES
Video Guide
Birth and the Newborn Child (9:03; p. 83)
Labor and Delivery (7:11; p. 86)
Neonatal Reflexes (1:15; p. 106)
Taste (2:02; p. 108)
Cultural Focus
Breast-Feeding Practices Across Cultures (6:19; p. 113)
1. Were you surprised to see that many of the women interviewed have similar reasons for
breast-feeding (regardless of their culture)? What are some of the benefits of breast-feeding that
they mentioned?
Answers will vary based on personal opinion. The benefits mentioned included:
breast milk is always with you
it is less expensive than formula
more natural
helps with bonding
Research Focus (pp. 116–117)
Breast-Feeding Benefits: Separating Correlation and Causation (3:45; p. 117)
Research Focus Answers
1. b
2. c
Soothing Methods (p. 121)
Applying Your Knowledge as a Professional
Career Focus: Birth Doula (p. 125)
Critical Thinking Questions and Answers
Section 1
If you were pregnant or the partner of a pregnant woman, how “natural” would you want
the childbirth to be, and why? (p. 92)
94
Students will have many answers to this, based on their own experience, what they have read,
and what they desire. As an instructor, you can help students weigh their options by not passing
judgment on any particular preference. Some students will want to go completely natural, with
no drug intervention, even avoiding the hospital and birthing at home. Other students may want
to take advantage of every possible medical intervention, such as using epidurals and birthing at
a hospital. There are many options for women, and they should become informed about all their
options to make the best choice for them.
Section 2
Given what you have learned here about neonate’s sight preferences, how would you
design a mobile for your newborn’s room? (p. 110)
It is typical for mobiles to have interesting designs, using colors with high contrast, such as
black, white, and red. Infants prefer faces over non-faces, and they prefer strong patterns over
random ones. They also prefer three-dimensional over two-dimensional objects, so you might
consider making a mobile out of small plush toys in black, white, and red patterns.
Section 3
Given that the benefits of breast-feeding in developed countries are genuine but small,
should public policies encourage or discourage more women to breast-feed for longer?
Consider the arguments that breast-feeding makes returning to the workplace difficult for
women and makes it hard for mothers and fathers to share the infant care equally. (p. 116)
Public policies should encourage breast-feeding. A longer period of breast-feeding has been
linked to higher IQ in early childhood. Breast-feeding is also linked to the quality of attachment
between the mother and child. Public policies that encourage longer breast-feeding could also
encourage more flexible design of workspaces to allow for onsite infant daycare, and they can
encourage more flexible schedules, so that mothers can breast-feed their children. Although
breast-feeding is not an activity a father can actively engage in, a father or other partner can
participate in many other aspects of child care that contribute to a secure attachment bond and
the child’s overall health and well-being.
95
Considering that colic places neonates at risk for parental maltreatment, how would you
design a program to prevent such maltreatment?
Educate prospective parents about what is expectable behavior from an infant (including crying
and the symptoms of colic) and give parents coping skills to deal with their own stress and their
own reactions to a colicky baby. You might also remind parents that colic is somewhat common
(about 1 in 10 Western babies experience it) and usually declines after 3 months of age.
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